With the increased use of cannabis in the US, there is a significant need to understand the medical complications associated with its use in relationship to a surgical population. Cannabis has mainly been studied with respect to its qualities of pain treatment, yet few studies have investigated post-surgical complications associated with its use. Therefore, the purpose of this study was to explore the effect of cannabis use on complications in spine surgery, and compare these complications rates to opioid-related complications. This was a retrospective study conducted using the PearlDiver Database. Using ICD codes 40,989 patients that underwent lumbar spine fusion between January 2010 and October 2020 were identified and divided into 3 study groups (i.e., control, patients with known opioid use disorder, and patients identified as cannabis users). Differences in the incidence of complications within 30 days of the index procedure and pseudarthrosis rates at 18 months postindex procedure were assessed among study groups using a multivariate logistic regression. Of 12.4% study population used cannabis and 38.8% had a known opioid use disorder. Results indicated increased odds of experiencing a VTE, hypoxia, myocardial infarction, and arrhythmia for both opioid and cannabis users compared to controls; however, when controlling for tobacco use there were no increased odds of complications within the cannabis group. The pseudarthrosis rate was greater in cannabis users (2.4%) than in controls (1.1%). The pseudarthrosis rate was significantly greater in patients using cannabis and opioids compared to the control group. However, when controlling for tobacco use, results suggested a possible negative synergistic between cannabis use and concomitant tobacco use that may influence bone fusion.

Study Design: Retrospective study. Background: Non-operative treatment for patients with spinal ankylosing disorders presenting with extension type fractures (AOSpine B3) has been disregarded due to reports of poor outcomes including secondary fracture displacement and unacceptably high mortality rates. Recent studies have questioned the prevailing recommendation for surgical management, advocating for reconsideration of non-operative treatment in appropriate cases. We aim to further identify patient and radiographic factors favoring successful non-operative management. Methods: A retrospective analysis was conducted using data from Royal North Shore Hospital spine consult database. Patients with AOSpine B3 fractures treated non-operatively between 2021-2023 were included. Demographic, clinical, and radiographic data were collected and assessed, including outcome analysis of specific fracture patterns. Results: A total of 40 patients were treated non-operatively. 30 were deemed appropriate for non-operative management based on initial imaging assessment. Complications and 6-month mortality occurred in 13% of patients in this group. No patients failed non-operative management and good clinical and radiologic outcomes were observed in all patients on follow up. An additional 10 patients required surgery but were deemed medically unfit. Patients in this group were found to have a mortality rate of 80%. Conclusions: Non-operative management appears feasible for selected patients with DISH and AOSpine B3 fractures of an osseous or osseous-discal pattern, without posterior vertebral wall/annulus involvement and an anterior opening of up to 6 mm. These findings suggest non-operative treatment with close clinical and radiological follow up for specific patients is a viable treatment method in this patient group.

Study Design: Efficacy study. Objectives: To elucidate the limitations of radiography in patients with spinal ankylosing disorders (SAD) with an emphasis on thoracolumbar injuries, which have been less focused upon. Methods: We searched our hospital’s emergency room database for patients who underwent a total spine computed tomography (CT) following a diagnosis of SAD on radiographs following a minor fall. A high-quality presentation containing 50 randomly situated anteroposterior + lateral radiographs was created. Of these, 24 contained a hyperextension type fracture diagnosed by CT. Twelve physicians—4 spine surgeons, 4 senior orthopedic residents and 4 junior orthopedic residents were requested to identify the pathologic radiographs and note the fracture level. Results: Fracture diagnosis stood at 65% for the best reader. When examining the different subgroups, the mean rate of diagnosis for spine surgeons was 55% and for orthopedic residents 32%. Mean diagnosis of thoracic fractures was 26%, of lumbar fractures was 55%, and for the entire thoracolumbar spine was 40%. The interobserver agreement (kappa coefficient) was found to be 0.37 for the entire group and 0.39 for spine surgeons. This finding was statistically significant. Conclusions: The simple radiograph is an inefficient modality for diagnosis of hyperextension type thoracolumbar fractures in patients with SAD. The poor interobserver agreement rate further amplifies this finding. Advanced imaging is recommended in these patients.

Study Design: Prospective cohort study. Objectives: In this study we aim to assess the difference in triggered EMG readings throughout different depths in the psoas muscle during the lateral approach to the lumbar spine and their effect on surgeon decision making. Methods: Three surgeons, practicing at different institutions, assessed triggered EMG readings during the trans psoas approach at the level of the disc and 5,10 and 15 millimeters into the psoas muscle with sequential dilators. Measurement of distance into the psoas muscle was done with a specially designed instrument. Results of anterior and posterior directed stimulation as well as the delta value between these were recorded and underwent statistical analysis. Patients who had partial readings were excluded from the study. Results: A total of 40 levels in 35 patients were included in the study. There was no significant difference found between means of anterior or posterior threshold readings along the different distance groups. A significant difference was found ( P = .024) in the mean difference between the distance groups with a decrease in the difference between anterior and posterior threshold values found as the distance from the disc space increased. None of the surgeons reported a decision to abort the fusion of a spinal level. Conclusions: In the trans-psoas approach to the lumbar spine, the assessment of the location of the femoral nerve using directional neuromonitoring when advancing in the psoas muscle shows no clear benefit as opposed to stimulating solely when adjacent to the disc space.